Medicare covers some at-home care, but not all of it, and the rules are strict about what kind of care qualifies

Medicare will pay for skilled nursing care, physical therapy, occupational therapy, and speech therapy delivered in your home — but only if a doctor orders it, you are homebound or nearly homebound, and a Medicare-approved home health agency provides it. Medicare does not pay for help with daily living tasks like bathing, dressing, or meal preparation unless those services are part of a skilled care plan. The difference between what Medicare covers and what it does not is the difference between medical care (which it pays for) and personal care (which it does not).

Home health care under Medicare is free after you meet your Part A deductible, with no copay for the skilled services themselves. However, you may owe 20 percent of the cost of medical equipment like walkers or oxygen. If you need ongoing personal care — someone to help you bathe or take medications — Medicare will not pay for that, and you will need to look at Medicaid, private pay, or long-term care insurance instead.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy services delivered at home, but only if a doctor orders them and a Medicare-approved agency provides them.
  • You must be homebound or nearly homebound — meaning leaving home requires considerable effort and is medically contraindicated — to receive Medicare-covered home health care.
  • Personal care services like bathing, dressing, and meal preparation are not covered by Medicare, even if you need them daily.
  • Home health care under Medicare is free after your Part A deductible, but Medicaid or private pay covers ongoing personal care that Medicare does not.

What Medicare Part A Covers at Home

Medicare Part A covers skilled nursing care — wound care, injections, catheter management, and monitoring of medical conditions — when delivered by a licensed nurse in your home. It also covers physical therapy (helping you regain strength and mobility after injury or surgery), occupational therapy (relearning daily tasks), and speech-language pathology (swallowing and speech problems). Medical social services and home health aide services are covered only when they are part of a skilled care plan ordered by your doctor.

The key requirement is that a doctor must order the care and document that it is medically necessary. The home health agency must be Medicare-approved, which you can verify by calling the agency directly or checking the Medicare.gov provider search tool. The care must be intermittent, not 24-hour live-in care — Medicare does not pay for someone to stay in your home around the clock.

You also receive durable medical equipment (wheelchairs, walkers, oxygen, hospital beds) at no cost after your Part A deductible, though you may owe 20 percent of the approved amount for some items. Medications and supplies used during home health visits are covered, but prescription drugs you take at home are covered under Part D, not home health.

What Medicare Does Not Cover at Home

Medicare does not pay for personal care services — bathing, dressing, grooming, toileting, or meal preparation — unless a nurse is present as part of a skilled care visit and documents that these tasks are medically necessary to the treatment plan. If you need someone to help you bathe every day but you do not need skilled nursing, Medicare will not pay for it.

Medicare also does not cover custodial care, which is ongoing information with activities of daily living when no skilled medical service is involved. It does not pay for homemaking services like cleaning, laundry, or grocery shopping. It does not cover 24-hour live-in care, adult day care, or care in an assisted living facility. If you need ongoing help with personal care, you will need to pay out of pocket, use Medicaid (if you meet income and asset limits), or rely on a long-term care insurance policy if you have one.

How to Get Medicare Home Health Care

The process starts with your doctor. Tell your doctor that you are having difficulty with mobility, wound care, therapy, or another medical issue that requires home-based treatment. Your doctor will assess whether home health care is medically necessary and write an order for it. The order must specify what type of care you need, how often, and for how long.

Once your doctor has written the order, you or your doctor can contact a Medicare-approved home health agency. You can find agencies in your area by calling your local hospital discharge planner, asking your doctor for a referral, or searching Medicare.gov. When you contact an agency, give them your Medicare number and your doctor's order. The agency will schedule an intake visit, usually within a few days, where a nurse will assess your home and create a care plan.

The agency bills Medicare directly. You do not submit a claim yourself. After your Part A deductible is met, you owe nothing for the skilled services. If Medicare denies a claim, the agency must notify you in writing, and you have the right to appeal.

The Homebound Requirement

To receive Medicare home health care, you must be homebound or essentially homebound. This does not mean you never leave your house. It means leaving home requires considerable effort, is medically contraindicated (your doctor says you should not), or is possible only with help from another person or medical equipment. If you can drive to a doctor's appointment or go to the grocery store on your own, you may not meet this requirement.

The home health agency assesses your homebound status during the intake visit. If Medicare later determines you are not homebound, it will deny payment for the visits. Some people lose coverage because they improve enough to leave home without difficulty — which is actually a sign the therapy worked, but it also means Medicare stops paying.

How Long Medicare Covers Home Health Care

There is no set time limit for Medicare home health care. Coverage continues as long as your doctor orders it, the agency provides it, and you remain homebound. However, Medicare reviews your case regularly. If you stop improving or no longer need the services, Medicare may stop paying.

Most home health episodes last between 4 and 12 weeks, though some people receive care for months. Your doctor and the home health agency will work together to set goals — for example, regaining the ability to walk after surgery or learning to manage a new medication. Once those goals are met or it becomes clear they will not be met, the agency will discharge you from home health care.

If you are discharged but later need home health care again, your doctor can order it again. There is no limit on the number of times you can receive home health care during your lifetime.

Medicare Advantage and Home Health Care

If you have a Medicare Advantage plan (Part C), your coverage for home health care works differently than Original Medicare. Most Medicare Advantage plans cover home health care, but the rules, copays, and approved agencies may differ from Original Medicare. Some plans require you to use agencies in their network, and some charge a copay per visit.

Before you need home health care, call your Medicare Advantage plan and ask what home health services are covered, whether there is a copay, and which agencies are in-network. If you are hospitalized and discharged to home health care, the hospital discharge planner should know your plan's rules, but it is worth confirming yourself. If your plan does not cover the care your doctor ordered, you may be able to appeal or switch to Original Medicare during the annual enrollment period.

Paying for Care Medicare Does Not Cover

If you need personal care services that Medicare does not cover, you have several options. Medicaid covers personal care and homemaking services in most states, but you must meet income and asset limits (which vary by state). Some states have waiting lists for Medicaid home care services, so even if you are may be able to access, you may wait months for care to start.

Long-term care insurance, if you have a policy, may cover home care. Check your policy documents or call your insurance company to see what services are covered and what you owe out of pocket. Private pay means hiring and paying a home care aide or agency directly with your own money. Costs vary widely by region and the level of care needed, typically ranging from $20 to $30 per hour for basic personal care, though rates are higher in urban areas and for specialized care.

Some people combine sources: Medicare pays for skilled nursing, Medicaid covers personal care, and private pay fills gaps. A social worker at a hospital or your local Area Agency on Aging can help you understand what you are may be able to access for and how to coordinate benefits.

Frequently Asked Questions

Can I choose which home health agency provides my care?

Yes. Your doctor writes the order, but you can choose any Medicare-approved agency. If your doctor has a preferred agency, you can use it, but you are not required to. Ask the agency if they are Medicare-approved before you commit. If an agency is not approved, Medicare will not pay.

What happens if I improve and no longer need home health care?

Your doctor and the home health agency will discharge you from care. This is a good thing — it means the therapy worked. If you need home health care again later, your doctor can order it again. There is no penalty for being discharged and restarting care.

Does Medicare cover home health care after I leave the hospital?

Yes, if your doctor orders it and you meet the homebound requirement. Many people receive home health care after hospitalization for surgery, illness, or injury. The hospital discharge planner can help arrange it, but your doctor must write the order for it to be covered.

What if my home health agency says I owe a copay?

Under Original Medicare, you owe nothing for skilled home health services after your Part A deductible is met. If an agency asks for a copay, ask them to verify your coverage. If you have a Medicare Advantage plan, you may owe a copay — check your plan documents or call the plan to confirm what you owe.

Can I get home health care if I live in an assisted living facility?

Yes. Medicare covers skilled home health care in assisted living facilities, independent living communities, and other residential settings, as long as you meet the homebound requirement and a doctor orders the care. The rules are the same as for care in a private home.